RESUMO
A 48-year-old woman was scheduled to undergo wrist surgery at the orthopedic surgery clinic. She was adventitiously diagnosed with miliary tuberculosis and saccular-type aneurysms in the suprarenal abdominal aorta and descending thoracic aorta during preoperative examination. Consequently, she received antituberculosis medications. However, the abdominal aortic aneurysm had enlarged rapidly 2 months later. Accordingly, we used an artificial graft patch bonded with rifampicin for the abdominal aortic aneurysm and resected the aneurysm and reconstructed the aorta through partial extracorporeal circulation by clamping the descending thoracic aorta and infrarenal abdominal aorta. Finally, we performed a thoracic endovascular aortic repair of the thoracic aortic aneurysm. Culture of the samples from the wall of the abdominal aortic aneurysm indicated Mycobacterium tuberculosis; therefore, the patient was diagnosed with a tuberculous aneurysm of the aorta. Her postoperative course was good, and she was discharged on day 36. At postoperative month 7, the patient is still on antituberculosis medications and has not experienced a recurrence.
RESUMO
Multiple ventricular septal defects (VSD) are traditionally considered as surgical challenges and often ventriculotomy is needed. We report our experience with single patch closure of multiple VSDs in 4 children with a median weight was 5.6 kg. VSDs were closed via right atrium with a single Goretex patch with no operative death and short mean intensive care stay. To conclude, surgical approach to multiple VSDs is still a challenge, but a select approach to septate through right atrium adds to the surgical armamentarium to handle this difficult problem.
RESUMO
Gerbode defect is a communication between the left ventricle and right atrium. It is usually congenital rather than acquired, but can occur as a complication of endocarditis, myocardial infarction, trauma, or cardiac surgery. We report a case of surgical repair of acquired Gerbode defect resulting from infective endocarditis. A 69-year-old woman with aortic regurgitation due to infective endocarditis was referred to our hospital with a diagnosis of congestive heart failure. She was hospitalized and underwent medical treatment (intensive antibiotic therapy). Preoperative transthoracic and transesophageal echocardiography were performed and revealed a mobile mass (vegetation) on the aortic valve. The patient also had severe aortic regurgitation and a communication between the left ventricle and right atrium. The communication was visualized in the atrioventricular membranous septum. Due to the mobility of the mass (vegetation) and uncontrollable congestive heart failure caused by severe aortic regurgitation, surgical treatment was advised. Surgery was performed through a median sternotomy with the patient on cardiopulmonary bypass. After aortic cross-clamping, the vegetation was approached through a horizontal incision in the ascending aorta and a right atriotomy. The communication site from the left view was below the commissure between the right coronary and non-coronary cusps ; from the right view, it was just above the tricuspid annulus of the septal leaflet. The defect was closed with two 0.4-mm thick Gore-Tex cardiovascular patches : one was placed on the LV side and the other on the RA side. The aortic valve was replaced with a bioprosthetic valve (SJM Epic 21 mm). The operation was finished and her clinical course was almost uneventful.
RESUMO
A 69-year-old woman with a medical history of mitral valve replacement for infective endocarditis 14 years previously was recently admitted after being given a diagnosis with multiple cerebral infarction along with headache and speech disturbance. After emergency admission, both transthoracic and transesophageal echocardiographies revealed multiple, extensive vegetation on the mitral prosthetic valve. Based on these findings, we diagnosed prosthetic valve endocarditis with cerebral septic embolization ; and immediate mitral valve re-replacement surgery was performed. During the operation, a complication occurred when the left ventricular posterior wall ruptured during withdrawal from the cardiopulmonary bypass after mitral valve re-replacement. After a second cross-clamp and resection of the mitral prosthetic valve, we repaired the myocardial laceration and repeated the mitral valve re-replacement. We selected the following two methods from different approaches to repair the left ventricular rupture : (a) exclusion of the myocardial laceration using a bovine pericardial patch (intracardiac approach) ; and (b) direct suturing of the bleeding epicardium (extracardiac approach).Seven days after the surgery, computed tomography (CT) revealed a pseudoaneurysm in the left ventricular posterior wall. Several follow-up examinations using CT and echocardiography revealed gradual enlargement of the pseudoaneurysm. At 112 days after previous surgery, we successfully repaired the pseudoaneurysm through left lateral thoracotomy using the femorofemoral bypass with hypothermia. In the final surgery, we closed the orifice of the pseudoaneurysm using bovine pericardium. This case highlighted that left thoracotomy using a femorofemoral bypass with hypothermia could be a useful approach to address a left ventricular posterior wall pseudoaneurysm.
RESUMO
<p>A 66-year-old man experiencing fever and dyspnea was transferred to our hospital 2 years ago. He had been on hemodialysis for 30 years due to chronic renal failure and was observed as having aortic stenosis for 5 years. Severe mitral regurgitation and complete atrioventricular block caused by infective endocarditis (IE) were noted. Thus, he emergently underwent double-valve replacement (DVR) and pacemaker implantation. The range of infection extended widely to the right atrium and atrioventricular septum beyond the mitral annulus. The infection was suppressed by perioperative antibiotic therapy. Transthoracic echocardiography (TTE) revealed a cavity approximately 30 mm in diameter in the left ventricle, which was located under the mitral annulus, and it extended to the right atrium 3 months after the operation. A diagnosis of left ventricular pseudoaneurysm associated with IE was then made. Because of progressive expansion of the aneurysm, we performed another operation 2 years after the previous one. The pseudoaneurysm was located in the region of the Koch's triangle, which indicated that it was caused by mitral annular abscess. We closed the orifice of the aneurysm approximately 20 mm in diameter with a polyester patch with a diameter of 35 mm. Postoperative TTE showed that the pseudoaneurysm was thrombosed and had no blood flow. Pathological examination of the wall of the pseudoaneurysm revealed that it consisted of fibrous tissues without myocardium. We encountered a rare case treated by patch closure for the left ventricular pseudoaneurysm after DVR associated with IE.</p>
RESUMO
We report a case of surgical repair of acquired left ventricular-right atrial communication resulting from infective endocarditis. A 70-year-old man with aortic regurgitation due to infective endocarditis was referred to our hospital because of congestive heart failure. Preoperative transthoracic echocardiography showed severe aortic regurgitation and left ventricular-right atrial shunt flow. He underwent surgery following intensive antibiotic therapy. The fistula was located at the atrioventricular membranous septum. The communication site from the left ventricular view it was below the commissure between the left and the non-coronary cusps, and from the right atrial view it was above the tricuspid annulus of the septal leaflet. The fistula was closed with autologous pericardial patch from the aortotomy and a mattress suture from the right atriotomy. Aortic valve replacement was performed simultaneously. The postoperative course was uneventful. He was in sinus rhythm all the time. It is important to discuss surgical procedure preoperatively with precise echocardiographic examination.
RESUMO
A 65-year-old man was admitted with subacute myocardial infarction. During medical treatment, the patient lost consciousness as a result of an atrioventricular block and underwent an operation for an emergency percutaneous coronary intervention in the right coronary artery. In a follow-up examination, transthoracic echocardiography and computed tomography showed a left ventricular pseudo-false aneurysm, and therefore another operation was carried out. The operative findings showed that the heart markedly adhered to the pericardium and the aneurysm at the apex. The patient then underwent a double-patch closure of the ruptured point using an equine pericardial patch and a Dacron patch. No perioperative complication was observed. Left ventricular pseudo-false aneurysm is a rare complication following myocardial infarction. Here, we report a successful case of a double-patch closure of a pseudo-false aneurysm.
RESUMO
A 65-year-old woman was referred for progressive dyspnea and leg edema. Physical examination revealed a continuous murmur along the right sternal border. Enhanced computed tomography showed an aneurysm that extended to the right atrium. Aortic angiography confirmed the rupture of the valsalva aneurysm into the right atrium. The patient underwent emergency surgery to close the aneurysm ostium and suture closure of the right atrial fistula. The patient's postoperative course was uneventful.
RESUMO
A 62-year-old man with a history of insulin-dependent diabetes mellitus was admitted to our hospital because of a high-grade fever and general fatigue. Laboratory data showed evidence of inflammation and <i>Streptococcus pneumoniae </i>was identified in the blood cultures. Transthoracic echocardiography revealed vegetations on the right coronary cusp of the aortic valve and septal leaflet of the tricuspid valve, and an aorto-right ventricular fistula secondary to abscess formation in the aortic annulus. We diagnosed active infective endocarditis with an aorto-cavity fistula and performed an emergency operation. The infected tissue was curetted as much as possible and the fistulous openings in the right ventricle and aortic root were closed using bovine pericardial patches. We subsequently performed aortic annular reconstruction and aortic full-root replacement using a Freestyle<sup>®</sup> stentless valve. Although a permanent pacemaker was implanted to treat a complete atrioventricular block, the postoperative course was uneventful and the C-reactive protein level normalized. He was discharged on the 46th postoperative day. Postoperative echocardiography revealed no signs of valve dysfunction, recurrent endocarditis, or residual abscess cavity and shunt. Infective endocarditis with abscess formation complicated by a fistula formation between the cardiac chambers is rare, and surgical treatment for this is challenging. In such cases, both radical debridement of the infected tissue and precise closure of the fistulous tract are essential.
RESUMO
Cardiac ruptures are life-threatening complications after acute myocardial infarction. Types of rupture include left ventricle free-wall rupture, ventricular septal rupture, and papillary muscle rupture. Double rupture is defined as the coexistence of two of the above-mentioned forms of rupture. It complicates approximately 0.3% of acute myocardial infarction with the most frequent combination being free-wall rupture and ventricular septal rupture. We present the case of a 74-year-old man whose recent acute myocardial infarction was complicated by a combination of free-wall rupture and ventricular septal rupture. The patient underwent successful surgical treatment of the double myocardial rupture along with bypass grafting.
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A 60-year-old man was referred to our hospital for surgical treatment of sinus of Valsalva aneurysm and aortic regurgitation. He had suffered from palpitation and leg edema since a month before. Echocardiography revealed right sinus of Valsalva aneurysm dissecting into interventricular septum complicated with aortic and mitral regurgitation. He successfully underwent patch closure of aneurysm, aortic valve replacement and ring annuloplasty of mitral and tricuspid valve. His postoperative course was uneventful.